Archive for the ‘Cellulitis’ Category

New! From The Wilderness Medicine Newsletter

February 10, 2012

For decades the Wilderness Medicine Newsletter has provided up-to-date information to pre-hospital and definitive care providers. Since becoming an on-line journal, the readership of the WMN has become international. Now the WMN has it’s own web site:

Subscribers pay the same $15 a year subscription rate but have access to more than 165 articles from back issues as well as current issues. You can search the site either by category, or by key words making the Wilderness Medicine Newsletter site a much more useful reference for everything from reviewing splinting to the prevention and treatment of tropical diseases.

Check it out!

Soft Tissue Injuries #4 – Abscess Formation

January 10, 2007

The Principles of Incision & Draining of an Abscess:

Picture – Assess and evaluate the abscess and surrounding anatomy.
Prep – clean and prep the area of the skin to be incised.
Pain control – if possible numb the skin with ice or inject with lidocaine.
Puncture the abscess – with a scalpel or sharp knife pierce the abscess.
Purge – gently compress and drain the abscess.
Purify – rinse the abscess clean with iodine solution.
Protect – cover with a sterile dressing and monitor during evacuation.

Stitches & Wound Closure:

  • Wounds edges may be approximated but, they should not be closed unless the wound can be thoroughly cleaned and closed in sterile fashion.Wound repair and closure is rarely functional; it is almost always cosmetic.If a wound heals with a scar, the scar can later be removed and the wound sutured closed for a better result.

    Bite wounds should never be closed as they are very dirty wounds, from the bacteria from the animal’s mouth. 

    Always consider tetanus booster for dirty wounds. Tetanus immunization is good for 10 years.

    Always consider rabies prophylaxis for animal bites.

So, in the wilderness setting:

  • Control bleeding.

    Properly and thoroughly scrub and clean the wound.

    Approximate the edges, but do not close the wound.

    Dress and bandage the wound to protect and promote healing.

    With loss of function splint to support the extremity.

    Change dressings at least two times per day.

    Monitor for signs of infection.

    If the wound is going to continue to get wet, use iodine wet-to-dry dressings to prevent infection.

For more detailed information on wilderness and long-term management of Soft Tissue Injuries see the Jan/Feb 2006 and the March/April 2006 issues of the Wilderness Medicine Newsletter.

Soft Tissue Injuries: #3 Wound Infections

January 8, 2007


Recognition and Management of Cellulitis:
Monitor the wound site for the initial immune response to the multiplying bacteria.
Signs & Symptoms of a wound infection – cellulitis:
Rubor:  The redness of the skin caused by the vasodilation.
Tumor:  Swelling of the soft tissue by the fluids that are escaping the dilated vasculature.
Dolor:  Pain caused by the swelling in the tissues.
Calor:  Warmth in the tissues from the vasodilation.
As the infection progresses:
Purulence: Pus formation, a collection of white blood cells (WBC’s) 
Lymphangina: red, tender streaks that progress up the extremity as the lymphatics become infected.
Lymphadenopathy: swollen, tender lymph nodes that occur when the infection reaches the lymph nodes proximal to the area of cellulitis.
If the infection reaches the central circulation, via the lymphatic drainage, then septic shock occurs with high fever, shaking rigors, tachycardia, and hypotension.

Hot water soaks of the area of cellulitis with non-scalding hot water and Epsom salts.  
The area of cellulitis should by heat soaked every 4 hours for at least 30 minutes, until the infection has resolved.  
If the infection continues to spread with lymphangina, lymphadenopathy, or purulence, consider an oral antibiotic such as penicillin, erythromycin, or trimethoprim/sulfamethoxazole (Bactrim).

For more detailed information on wilderness and long-term management of Soft Tissue Injuries see the Jan/Feb 2006 and the March/April 2006 issues of the Wilderness Medicine Newsletter.

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